CHIP-ing Away at Bush

Congress is likely to take its first meaningful swipe at the Bush era today by passing a long-awaited expansion of the public health insurance program for poor children. We spend more than $2 trillion a year on health care and still leave 1 in 9 kids without coverage, but Bush twice found reason to veto an expansion of the program. Twice. The bill before Congress now would reauthorize the program for another 4.5 years, cover an additional 4.1 million poor kids and pay for it by taxing cigarettes.

If passed, the bill will also be the first tangible victory for black folks to come out of the new reign of Barack Obama and the Democrats. The State Children’s Health Insurance Program has cut the number of uninsured black kids by half since it began in 1997, and 60 percent of the estimated 9 million kids who still aren’t insured are black, according to Families USA.

The House will vote on the bill today or tomorrow; the Senate will begin deliberation in the Finance Committee tomorrow.

Republican opposition hasn’t waned, of course. GOP House members sent a letter of objection to Nancy Pelosi on Monday (the first of what will no doubt be many largely symbolic outcries from the defanged House Republican caucus over the next two years). Like Bush, House GOP leaders have thrown a host of complaints at the Capitol wall in the hopes that one will stick—it’s too costly ($33 billion); it ignores the larger question of fixing Medicaid; it covers people who could get private insurance.

This last claim has been the most absurd of the Bush/GOP objections to SCHIP’s reauthorization and expansion. The Congressional Budget Office has said four out of five of the 4.1 million additional kids who the bill would cover are in families with incomes that should already qualify them for coverage, if there was enough money.

It’s worth noting that the bill falls short of Obama’s campaign pledge to cover every child—misses the mark by half, in fact. As the Washington Post’s story today noted:

"This is certainly not the promise to cover every child that the president-elect ran on," said Susan Gates, general counsel at the Children's Defense Fund, who said the legislation would still leave as many as 5 million children with no insurance and millions more with intermittent or partial coverage...

Advocates for the bill, while cheering its revival, fear that an early victory could take pressure off Obama and congressional Democrats to go further. "I am concerned there will be a sense we're done with this and move on to the next issue," said Irwin Redlener, a ColumbiaUniversity professor and president of the Children's Health Fund.

There’s also the question of whether immigrant children ought to be able to go to the doctor, too. From the start, SCHIP has required children of legal immigrants be in the country for five years before getting coverage. That’s one of the less sensible and more racist examples of policymaking Washington has churned out in modern times.

Bush and his Republican colleagues have steadfastly blocked a change to the rule. The House bill would repeal it, however, leaving it to states to decide whether and how to cover immigrant kids. The Senate bill’s most recent version leaves the silly rule in place, but Finance Committee Chair Sen. Max Baucus has said he’s open to a change.

There are few better examples of how wasteful America’s obsession with private insurance has been than the delay in reauthorizing and expanding SCHIP. The program has been an unmitigated success—for those it has reached. Those it has failed to reach are left to fend for themselves in a private insurance system that fails them; 9 out of 10 uninsured kids live in families with working parents whose jobs don’t provide enough to send their kids to the doctor. Ultimately, that drives up cost for everybody.